Improving the health of Americans depends increasingly on valid self-report measures of health. While important information can be obtained from administrative data and health records, measuring physical and emotional health status in the general population or in disease-affected groups requires direct assessment of individuals. Clinicians and researchers rely on self-report measures to understand treatment efficacy, symptom burden, medical decision making, and quality-of-life-though the self-report method is not without limitations. Unlike laboratory measures, which are generally reliable across individuals, self-report measures are affected by a variety of respondent factors, including personality traits, that reduce their validity. Illness and efforts to cope with its physical and emotional effects are now understood to alter survivors'perceptions of themselves and their subsequent health conditions. To the extent that individuals evaluate themselves differently following illness, interpretation of their self-reported health ratings is complex. To address this area of investigation, this research proposal responds to notice NOT-OD-10-032, "NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (R01, R03, R15, R21, R21/R33, and R37) through the NIH Basic Behavioral and Social Science Opportunity Network (OppNet)." Building on research in personality and social psychology, this study employs the construct of self-enhancement bias (SEB), defined as a characteristic tendency "to give self-reports that are honest but positively biased", 3 to investigate how changes in self-appraisal may affect self-report of health after cancer. Following pilot results, the study tests the hypothesis that SEB is associated with enhanced self-report of emotional well-being, but not physical well- being, on quality-of-life and distress measures in a group of 150 long-term survivors of childhood cancer. Utilizing a newly validated model and measure of SEB, the study investigates the psychometric properties of the scale in this population. This study expands on the goals of a currently funded study examining the extent to which SEB is 1) increased among Hodgkin's Lymphoma survivors compared to non-cancer controls, and 2) associated with reports of posttraumatic growth after cancer. By enrolling a new cohort of cancer survivors, the revision enhances the aims of the original R03 and makes it possible to study the effect of SEB on health outcomes more broadly. Study aims will be to: 1) Test the hypothesis that SEB is associated with enhanced self-report of emotional, but not physical, well-being on standard health measures;2) Investigate factorial and construct validity of the SEB measure;and 3) Explore the association of SEB with illness and treatment factors. Results will make an important contribution to understanding how adaptation to illness affects self- perception and will have important implications for the validity of self-reported health measures. PUBLIC HEALTH RELEVANCE: Self-report measures are essential to health research, but to the extent that individuals evaluate themselves differently following illness, interpretation of their self-reported health ratings is complex. This study investigates the ways in which recovering from cancer affects individuals'appraisals of health and well-being, and how these changes in health appraisal can affect the validity of self-report health measures. Results have important implications for understanding how adaptation to illness affects self-perception and self-presentation as well as improving health outcome measures.